DICOM meets special requirements in Japan

The DICOM standard has expanded beyond its original transmission of radiographic images to nonimage information. Scheduling management and information on performed procedures are now included, but hospitals in Japan have learned that DICOM hasn't gone far enough.

Hospital information systems and order entry systems are far more widespread in Japan than in the U.S. or Europe: 50% of all hospitals there with 300 or more beds have enterprise order entry systems. They now have a beed for transmitting order data to modalities to avoid repeat inputting.

Because HIS and imaging modalities are rarely supplied by the same vendor, nonimage data communications must be standardized, said Dr. Michio Kimura of the Medical Informatics Department at Hamamatsu University.

"However, it is considered inappropriate to transpose the DICOM standard into the Japanese environment without modification because of differences in diagnostic imaging procedures and special Japanese regulatory requirements for radiation recording," he said.

Kimura cited some examples:

?Some radiation recording items are mandatory in Japan, whereas they are not detailed enough in the DICOM standard. An example: exposure time.
?The contents of the order also must be specified in profound detail and are not sufficiently covered by items listed in DICOM.

Since these conditions are unique to Japan, the Japanese did not ask that DICOM itself be modified. Instead, they designed special codes.

Kimura chaired a taskforce that established the JJ1017 management guideline. This specified, for example, which items are legally required in Japan but remain optional in the DICOM standard. In Japan, the contents of orders from referring physicians for radiographic examinations include details of the examination. Such details are not used typically by referring physicians requesting radiographic examinations in the U.S. because U.S. radiologists often determine the examination protocol.

Kimura's paper reports the taskforce experience ( J Digit Imaging, DOI: 10.1007/s10278-002-0005-8, published online: 14 June 2002 http://dx.doi.org/10.1007/s00270-002-0005-8 ).

Final interconnection using the JJ1017 guideline was demonstrated at the CyberRAD exhibition last year. In the exhibition, image studies were accepted by HIS and RIS, order information was sent to imaging modalities using Worklist Management, and Performed Procedure was received by PACS, Kimura said.

In the demo, Fujitsu, Teijin Systems, Shimadzu, and Hitachi Medical participated for the HIS and RIS. Canon DR, Konica CR, Fuji Film Medical CR, Philips MR, and Shimadzu X-ray TV participated for the imaging equipment. ARRAY, Teijin Systems, Fujitsu, Toshiba, and Yokogawa participated for PACS.

Using the JJ1017 code, connections across different companies were made possible, according to Kimura.

"No disadvantage has been observed," he said.